"We spend the money, but we don’t always see the outcomes. It’s sobering to realize… the execution just isn’t there." – Tom Insel, former head of the National Institute of Mental Health.
California launched a groundbreaking initiative aimed at revolutionizing mental healthcare access for its students, but the ambitious "Master Plan for Kids’ Mental Health" is encountering significant hurdles in its execution. While the state has invested billions and mandated insurance reimbursement for on-campus behavioral health services, many schools, particularly those in rural areas, are struggling with administrative complexities, delayed payments, and inadequate support, jeopardizing the very access the program intended to provide.
QUINCY, Calif. – The promise of California’s sweeping initiative to integrate mental health services into schools initially resonated as a beacon of hope for communities like Quincy, where access to care is a perennial challenge. Taletha Washburn, executive director of Plumas Charter School, and her staff envisioned a transformative program that would bring much-needed mental health support directly to their students. However, the reality of implementing this first-in-the-nation plan has been a protracted and often frustrating journey, marked by bureaucratic inertia and systemic inefficiencies.
For two years, Plumas Charter School employees dedicated themselves to understanding and preparing for the state’s mandate. This involved a relentless cycle of state-led webinars, intricate form-filling, and extensive research into electronic health record systems, all in anticipation of being able to bill health insurance companies for behavioral healthcare provided on campus. "We were spinning our wheels," Washburn recounted, detailing months of waiting for state responses to their inquiries. The school finally received its inaugural reimbursement check in April, a modest $8,000, with at least $12,000 in outstanding claims. What was anticipated to be a "game changer" has, for now, proved to be a significant disappointment.
Plumas Charter School is one of approximately 1,000 public schools, community colleges, and universities participating in Governor Gavin Newsom’s ambitious endeavor. The initiative requires health insurance companies to reimburse educational institutions for on-campus behavioral healthcare services. This has spurred many schools to expand their mental health workforces, hiring counselors, therapists, and psychiatrists to provide accessible care within the familiar environment of school. The goal is to alleviate the months-long waiting lists families often face when seeking private mental health professionals.
However, five years after its inception, school officials across California are voicing concerns about a rollout plagued by inadequate state guidance, an incomplete billing infrastructure, a lack of standardized forms, and persistent delays in enrollment and payment. The state data reveals a stark reality: more than half of California’s school systems and colleges have not opted into the billing program. Among those that have, a mere fraction – fewer than one-fifth – had successfully filed claims as of June 1, according to the latest figures.
This slow uptake has significantly hampered the program’s ability to generate the projected half-billion dollars in annual revenue. This revenue was intended to offset the costs of thousands of mental health professionals, many of whom were hired with a surge of federal COVID-19 pandemic funding. With this funding now dwindling and the promised reimbursement stream proving unreliable, school districts across the state are facing difficult budget decisions, leading to thousands of layoffs.
State lawmaker Dawn Addis, a Democrat and former special education teacher, has been a vocal critic of the program’s sluggish implementation. "One of the things that makes people hate government is when we make a promise and then we struggle to keep that promise because we can’t get the administrative part of it up and running," she stated.
Governor Newsom’s office declined to make the governor available for comment. At a press conference earlier this year, Newsom lauded the initiative as "unprecedented" and asserted that "no other state in the nation has done more" to address the youth mental health crisis. He acknowledged the ongoing need for investment in mental wellness, stating, "We have a lot more work to do to deal with the crisis of our time. Making investments in wellness, not just physical health, but mental health for our kids, is a good investment." However, he did not directly address whether he considered the program a success.
Tom Insel, a former head of the National Institute of Mental Health who has advised Governor Newsom, suggested that the program’s rocky rollout is, in part, a reflection of its pioneering nature. Yet, he admitted, given the substantial investment, clearer evidence of dramatic improvement was expected. "What we struggle with in California is: We spend the money, but we don’t always see the outcomes," Insel observed. "It’s sobering to realize, especially as an advocate, that you could actually get the programs, get the money, get everything that you want from the policy side, but the execution just isn’t there."
A First-in-the-Nation Plan?
The urgency behind California’s initiative cannot be overstated. In 2021, a staggering 1 in 10 high school students nationwide reported attempting suicide, a grim statistic that positioned suicide as the second-leading cause of death for young people aged 10 to 24. In response, Governor Newsom unveiled a $4.4 billion "Master Plan for Kids’ Mental Health," a comprehensive strategy aimed at fundamentally overhauling California’s behavioral health system. Mental health experts recognized Newsom’s plan as the most ambitious statewide effort to confront a youth mental health crisis that had been exacerbated by the pandemic.
The state has allocated significant funds to bolster the mental health workforce, including $730 million in one-time funding for recruitment campaigns and student loan repayment programs. An additional $220 million has been directed towards fostering partnerships between local governments and school officials, while $381 million has been disbursed as grants to schools and community organizations for facilities and services. Furthermore, roughly $532 million has been invested in digital applications designed to connect families with counseling services and provide consultation support for primary care physicians managing behavioral health issues. State operations and program evaluations have also received $232 million.
Despite these substantial investments, the goal of adding 10,000 school counselors by the end of 2024, as pledged by Newsom, has fallen short. As of recent data, the state has added 1,855 school counselors since 2021.
The cornerstone of Newsom’s Children and Youth Behavioral Health Initiative (CYBHI) is its "flagship" component focused on schools, designed to expand on-campus behavioral health services at no cost to families. This component empowers schools to bill health insurers for these services. Nearly a third of the total investment, approximately $1.3 billion, has been earmarked for establishing campus wellness centers, developing new billing infrastructure, and enhancing school-based mental health support.
However, the process of filing claims has become an administrative quagmire for schools unfamiliar with the intricacies of medical billing. Trina Frazier, assistant superintendent of student services for the Fresno County Office of Education, described the launch of their medical billing system in February 2025 as "like building the plane while flying it." The delays were so severe that lawmakers authorized $20 million in grants to Fresno and 170 other school systems to prevent layoffs of newly hired mental health staff while awaiting reimbursements.
In contrast, the Anaheim Elementary School District in Orange County, recognized by state officials as a program "champion," has managed to recoup over $1.1 million since its 23 campuses began billing student insurance in February 2025. However, this figure represents less than 30% of the behavioral health services provided by the district during that period. Beyond the complexity of billing, parental reluctance to share health insurance information, particularly in a largely Latino district with lingering fears stemming from past immigration enforcement actions, has also presented a challenge.
To manage claims across the state, California contracted with Carelon Behavioral Health, a service operated by Elevance Health, for $65 million. Despite this, many schools have struggled to get claims approved and have incurred significant expenses, sometimes hundreds of thousands of dollars, by hiring external vendors to troubleshoot and process claims. As of June 1, Carelon had approved approximately 232,100 claims totaling over $11.3 million for 186 school districts and educational agencies, according to the Department of Health Care Services. This represents a fraction of the anticipated participants and falls far short of the $500 million per year that state officials projected for school-based mental health services.
"We probably were given the impression that this was going to happen more quickly and now there’s this reality of a kind of slow growth," commented Amy Blackshaw, behavioral health project director for the California School-Based Health Alliance.
Carelon contract manager Christina Kim declined to comment, referring inquiries to the state. Autumn Boylan, deputy director of the Office of Strategic Partnerships at the Department of Health Care Services (DHCS), stated that staff have incorporated feedback from school districts, extended claim deadlines, relaxed onboarding requirements, and provided webinars and office hours. However, she emphasized that changes of this magnitude require time. "We’re trying to help the school districts increase their scale," Boylan told lawmakers. "It’s not a problem of claims being submitted and not paid. It’s a problem of claims not yet being submitted for payment." Boylan noted that the volume of reimbursements has increased significantly since the first claims were filed in November 2024.
Meanwhile, the need for mental health services among California’s youth remains acute. In 2024, nearly 14% of individuals aged 12-17 reported delaying or skipping mental healthcare due to an inability to secure an appointment. Furthermore, one in four teens cited cost as a barrier, an increase from approximately 6.5% the previous year, according to data from the California Health Interview Survey. While the rate of young adults (18-24) who have seriously considered suicide has stabilized, it remains elevated compared to pre-pandemic levels. Additionally, although the suicide rate among Californians aged 12-25 has decreased from its 2021 peak, mirroring national trends, state rates for female and Black youth have unfortunately risen between 2023 and 2024.
"We have to have high expectations that when we invest in the magnitude of billions as this program did, we would have results to show," stated Assembly member David Alvarez, a Democrat from San Diego.
Other states are observing California’s implementation challenges, with some adopting a more focused approach. For instance, Illinois has concentrated on universal mental health screenings for schoolchildren, while Colorado has expanded coverage for behavioral health services for youth without formal diagnoses. Sharon Hoover, formerly co-director of the National Center for School Mental Health at the University of Maryland, noted that "It’s always hard to be first, and someone has to be brave enough and hopeful enough to take that leap." She added that launching the reimbursement program before the billing infrastructure was fully established created momentum but also posed significant difficulties. Nevertheless, Hoover believes Newsom’s emphasis on prevention and early intervention represents a major national policy shift.
Alex Briscoe, a principal at the nonprofit Public Works Alliance, who has advocated for systemic reform in children’s mental health, commented, "We’re going to look back on this thinking it was one of the most progressive actions in the history of public systems. We spent a significant amount of money preparing for it. I just don’t think we did that very well or strategically."
Rural Schools Struggle Most
The impact of these systemic issues is particularly pronounced in rural communities like Quincy. By the fall of 2021, students at Plumas Charter School had endured a cascade of trauma, including wildfires, COVID-19 lockdowns, and, tragically, a car accident that claimed the life of a classmate and severely injured two others. Teachers observed rising levels of depression, anxiety, and behavioral issues among their K-12 students, with nine reporting suicidal ideation that year—an all-time high. In response, the school hired a full-time therapist and wellness coach using temporary federal funds.
Will Coelho, a senior at Plumas Charter, arrived in Quincy a year later, grappling with his own significant losses, including the death of a friend in a murder-suicide shortly before the pandemic lockdowns. Isolated during the initial stages of the pandemic, Coelho struggled with grief. His stepfather’s increasing violence and a subsequent custody battle led him to move to Northern California just weeks before starting high school. A conversation with a faculty advisor led him to the school therapist, whom he began seeing weekly, free of charge, on campus. "It has had a large impact on the way I process emotions and my outlook on life," he shared.
Behind the scenes, however, school officials grappled with the sustainability of these vital services. Plumas Charter’s applications for the state’s landmark billing program were twice rejected. The state cited unmet requirements, such as the lack of robust systems for billing private insurers and collecting student insurance information. When school staff reported difficulties with online claims submission, state officials suggested submitting paper claims instead.
This experience has left Washburn and her staff disillusioned with the program, which she believes is ill-suited for small, rural districts where administrative roles are often consolidated. "We’re too small, and our funds are too limited to just keep waiting," Washburn stated, expressing doubt that her school will generate sufficient revenue to retain their therapist.
A spokesperson for DHCS, Tony Cava, noted that many charter schools are small and not expected to participate in the program. While charter schools constitute about half of eligible entities, they serve only 12% of California’s students. Lawmakers representing rural districts, however, argue that the program must be inclusive. Addis’s proposed legislation aims to provide intensive technical assistance to school officials in need. Even if passed, it may arrive too late to benefit Plumas Charter. Washburn remains uncertain about the school’s ability to continue funding its therapist, concluding, "In theory, this should be a good program."
